Excision can be done with a number of different tools and methods. There are mechanical tools such as scissors or a scalpel and others methods such as laser, vaporization, or electricity; all can be used to remove endometriosis implants from organs and tissues.
In many cases, the specific tool is not the key, but rather having a surgeon who is able to use a tool or tools in a skilled and expert manner to cut away existing implants. Some surgeons even use a combination of tools depending on the location of endometriosis.
Excision is important for a couple reasons. One, it leaves tissue intact so there is something to send to pathology to confirm diagnosis. Having positive proof of your diagnosis can help treatment decisions. Two, excision is less likely to leave remaining endometriosis implants that can continue to cause symptoms and problems.
Unfortunately, there are a limited number of surgeons in the United States, and even the world, with expert excision skills. Instead, many surgeons use an ablation method that burns the surface of the endometriosis implant using heat, laser, or cautery methods, which can cause more scarring and tissue damage. In addition to possible tissue damage, this method is also more likely to leave behind some of the endometriosis because it cannot reach deep implants, nor can it be used on all organs and tissues. Plus, ablating the implants leaves no tissue for pathology to confirm diagnosis.
Finding an endometriosis specialist who has the ability to excise your endometriosis could offer you the most optimal treatment option. It can take some time and effort to find this type of surgeon, but it can be well worth it!” http://www.hystersisters.com/vb2/article_562811.htm#.U9PsPmd0zAM
“Results: There was a reduction in all pain scores over the five year follow up in both treatment groups. A significantly greater reduction in dyspareunia VAS scores was seen in the excision group at 5 years (univariate p= .031 and multivariate p=.007). More women went on to use medical treatments for endometriosis amongst the ablation group (p= .004) by 5 years.
disruptors (Mori et al., 2003). Therefore surgery, if complete in exhausted growth disease can be considered curative. Contrarily, exposition to endocrine disruptors such as synthetic estrogens or SERM chemical compounds, though reducing the symptoms, could increase the growth of
"Several clinical studies suggest that the recurring endometriotic lesions arise from residual lesions or cells not completely removed during the primary surgery. Nisolle-Pochet et al. (1988) reported that in women who received microsurgical resection of ovarian endometriosis, a high prevalence of active endometriosis without signs of degeneration is found after hormonal therapy. Compared with women receiving no treatment, the mitotic index was similar in women treated for 6 months either with lynestrenol (a progestin), gestrinone (an androgenic, antiestrogenic and antiprogestogenic agent) or buserelin (a GnRH agonist) (Nisolle-Pochet et al., 1988). This suggests that hormonal treatment does not lead to a complete suppression of endometriotic foci and that recurring lesions appear to grow from the residual loci. Vignali et al. (2005) found that for those patients who underwent a second surgery, the recurrence of deep endometriosis is observed in the ‘same’ area of the pelvis involved in the first operation. Exacoustos et al. (2006) reported that of 62 patients with recurrent endometriomas, 50 (80.6%) had recurrence on the treated ovary, 7 (11.3%) on the contralateral untreated ovary and 5 (8.1%) on both the treated and untreated ovaries. Overall, the majority of recurrent cases (88.7%) have recurrence involving the treated ovary, suggesting that the recurring cysts seem to grow likely from the residual loci." http://humupd.oxfordjournals.org/content/15/4/441.full
"Above all, this report is directly at odds with the one reporting that recurrent symptoms still occur in about 10% of women even ‘after’ hysterectomy and bilateral salphingo-oophorectomy are performed (Namnoum et al., 1995). In fact, some earlier reports also found recurrence after hysterectomy. Sheets and Fetzer (1956) and Andrews and Larsen (1974) reported a 1–3% reoperation rate after hysterectomy with some ovarian conservation. Hammond et al. (1976) reported an 85% reoperation rate 1–5 years after hysterectomy surgery with ovarian conservation. Some anecdotal reports also documented the development of endometriosis after hysterectomy (Goumenou et al., 2003)." http://humupd.oxfordjournals.org/content/15/4/441.full
CONCLUSION: Laparoscopic excision of endometriosis results in a low rate of minimal persistent/recurrent disease. The natural history of endometriosis after surgery suggests a rather static nature of the disease." http://europepmc.org/abstract/MED/1833246
"Main outcome measures Effect of laparoscopic excision on pain scores and quality of life, operative findings, type of surgery, length of surgery and incidence of intra- and post-operative complications.
Results Patients with endometriosis were severely ill with significant pain and impairment of quality of life and sexual activity. Four months after radical laparoscopic excision for deep endometriosis there was significant improvement in all the parameters measured including their quality of life based on EuroQOL evaluation: EQ-5D (0.595:0.729, P= 0.002) and EQ thermometer (68.9:77.7, P= 0.008); SF12 physical score (44.8:51.9, P= 0.015); sexual activity (habit P= 0.002, pleasure P= 0.002 and discomfort P≤ 0.001). Only the mental health score of SF12 failed to show any statistical improvement (47 1:48.4, P= 0.84). Symptomatically, there was a significant reduction in dysmenorrhoea (median 8.0:4.0, P≤ 0.001), pelvic pain (median 7.0:2.0, P≤ 0.001), dyspareunia (median 6.0:0.0, P≤ 0.001) and rectal pain scores (median 4.0:0.0, P≤ 0.001). Complications were noted, but were deemed to be acceptable for the extent of the surgery.
Conclusions This is an early analysis of the first 57 cases studied, but structured evaluation suggests that meaningful improvements in clinical symptoms and quality of life can be obtained with this approach with acceptable levels of operative morbidity. Further follow up of this series is required, but early evidence would suggest that the technique should be further evaluated as part of a randomised trial." http://onlinelibrary.wiley.com/.../j.1471-0528.2000.../full
"Recent findings: Large, long-term, prospective studies and a placebo-controlled, randomized, controlled trial suggest that laparoscopic excision is an effective treatment approach for patients with all stages of endometriosis. The result of such laparoscopic excision may be improved if affected bowel, bladder and other involved structures are also excised. Adjuvant therapies such as the levonorgestrel intrauterine system and pre-sacral neurectomy may further improve outcomes. Ovarian endometrioma are invaginations of the uterine cortex, and surgical stripping of this cortex removes many primordial follicles. Despite this apparent disadvantage, stripping of the capsule is associated with better subsequent pregnancy rates and lower recurrence rates than the more conservative approach of thermal ablation to the superficial cortex.
Summary: Laparoscopic excision is currently the ‘gold standard’ approach for the management of endometriosis, and results may be improved with careful use of appropriate techniques and suitable adjuvant therapies." http://journals.lww.com/.../The_effectiveness_of...
"Surgical excision can be carried out by laparoscopy, laparotomy or vaginally using sharp dissection, electrosurgery or with the use of a CO2 laser. Excision is the treatment of choice because of a high pregnancy rate, a complete cure of pain in most women, and a low recurrence rate....The choice of treatment will therefore depend on the local expertise with minimal invasive surgery, certainly if a first excision has been incomplete and pain symptoms recur." http://journals.lww.com/.../Treatment_of_deeply...
...Complete excision of endometriosis, including vaginal resection, offers a significant improvement in sexual functioning, quality of life, and pelvic pain, including in those symptomatic patients with deeply infiltrating endometriotic nodules in the posterior fornix of the vagina.94 As well, the technique offers good results in terms of reduced bladder morbidity and bowel symptoms.95,96,97 However, in that this kind of surgery requires advanced skills and anatomical knowledge, again, it should be performed only in selected reference centers.95 " https://www.apgo.org/elearn/endo/endomonon2.pdf